2014~2015年中国澳門鏡湖醫院住院呼吸道感染兒童鼻咽部病毒病原學分析

Viral Etiology of acute respiratory tract infections in hospitalized children in Macao,china between 2014 and 2015

目的連續觀察分析中国澳門鏡湖醫院住院呼吸道感染兒童病毒病原學情况。方法採集本院2014年1月~2015年12月住院的2096例急性呼吸道感染患兒的鼻咽分泌物,用Luminex公司的xTAG RVP FAST V2檢測9種呼吸道病毒。結果2096例呼吸道感染患兒鼻咽分泌物標本中,陽性檢出率為77.1%(1615/2096),前4位依次為腸病毒/鼻病毒(EV/HRV)36.3%(586/1615)、腺病毒(ADV)23.7%(383/1615)、呼吸道合胞病毒(RSV)19.2%(310/1615)、副流感病毒(PIV)12.8%(207/1615),2種及2種以上病毒混合感染達18.9%。不同年齡組病毒總檢出率差異有統計學意義(χ^(2)=63.167,P<0.001),幼兒組檢出率最高為82.8%,其次為學齡前組為78.5%,學齡組最低為62.4%。RSV檢出率隨着年齡增長而降低,流感病毒(Flu)的檢出率隨年齡增長而增加。兩年四季中春、冬季病毒檢出率最高。喘息組患兒的病毒檢出率較非喘息組高,其中EV/HRV檢出率49.2%(95/193),其次RSV檢出率為36.3%(73/193)。ADV、Flu主要引起AURI。RSV、人偏肺病毒(hMPV)、PIV、人博卡病毒(HBoV)及人冠狀病毒(HCoV)主要引起下呼吸道感染(ALRI)。結論病毒是住院兒童呼吸道感染的主要病原體,腸病毒、鼻病毒、腺病毒、呼吸道合胞病毒在澳門地區兒童呼吸道感染疾病中佔重要地位。幼兒及學齡前期兒童易感呼吸道病毒,RSV在嬰兒檢出率最高,流感病毒、ADV在大年齡組檢出率高。RSV和EV/HRV在兒童喘息性疾病的發生發展中起重要作用。

Objective To study the viral epidemiological characteristics in children with acute respiratory tract infections(ARTI)in Macao.Methods Nasopharyngeal secretions were collected from 2096 children with acute respiratory tract infection in inpatient department from January 2014 to December 2015.Nine common respiratory viruses were analyzed by using xTAG Respiratory Viral Panel FAST V2.They include enterovirus(EV)/rhinovirus(RHV),adenovirus(ADV),respiratory synctyial virus(RSV),parainfluenza virus(PIV),influenza virus(Flu),human netapneumonia virus(hMPV),human bocavirus(HBoV)and human coronavirus(HCoV).Results The positive rate of detected respiratory viruses in children with ARTI was77%(1615/2096).The three most common viruses were EV/HRV(36.3%),ADV(23.7%)and RSV(19.2%.The rate of mixed infection with two or more viruses was 18.9%.The virus detection rate between age groups was significantly different(χ^(2)=63.167,P<0.001).The positive rate was highest in toddlers(82.8%),followed by preschoolers(78.5%).The detection rate of RSV decreased with age,whereas that of Flu was the opposite.The virus detection rate was highest in spring in the two years under analysis,followed by winter.The positive rate in wheezing patients(94.3%)was higher than in non-wheezing patients(75.3%).ADV and Flu mainly caused acute upper respiratory tract infections(AURI),whereas RSV,hMPV,PIV,HBoV and HCoV mainly caused acute lower respiratory tract infections(ALRI).Conclusion Respiratory viruses were the major pathogens of ARTI in children.EV/RHV,ADV,RSV and PIV are important etiological agents for children in Macao.Toddlers and preschoolers were more susceptible to infection by respiratory viruses.The detection rate of RSV,Flu and ADV were highest in infants,school children and preschoolers.RSV and EV/HRV play important roles in wheezing diseases of children.